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NPI Code Detail

MEDICARE: MAVIS REBECCA COOK CRNA

MEDICARE: MAVIS REBECCA COOK CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistAPN473SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922067206
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAVIS REBECCA COOK CRNA
Provider Business Mailing Address
First Line : 1236 RUTLEDGE AVE
Second Line :
City : FLORENCE
State : SC
Zip : 29505-3051
Country : US
Telephone Number : 843-669-2808
Fax Number :
Provider Business Practice Location Address
First Line : 555 E CHEVES ST
Second Line :
City : FLORENCE
State : SC
Zip : 29506-2617
Country : US
Telephone Number : 843-777-8752
Fax Number : 843-777-8705
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2006
Last Update Date : 03/08/2026

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Directions to “ MAVIS REBECCA COOK CRNA” Practice Location

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